HEMORRHOIDS Hemorrhoids are abnormally swollen veins in the rectum and anus. They are much like varicose veins you might see on a person's legs. When bulging hemorrhoidal veins are irritated, they cause surrounding membranes to swell, burn, itch, become very painful, and bleed. Too much pressure in the rectum causes hemorrhoids by forcing blood to stretch and bulge the walls of the veins, sometimes even rupturing them. Once the rectal veins have been stretched out and hemorrhoids created, they are difficult to get rid of completely and tend to recur with less straining than it took to cause them in the first place. Fortunately, good habits and simple medical treatment usually control hemorrhoids well, and surgery is only recommended in unusually severe cases. Some of the most frequent causes of hemorrhoids: Constant sitting Straining with bowel movements (from constipation or hard stools) Diarrhea Sitting on the toilet for a long time Severe coughing Childbirth Heavy Lifting There are two kinds of hemorrhoids: Internal hemorrhoids usually don't hurt or itch; they are deep inside the rectum and usually have no sensation. However, internal hemorrhoids can bleed. Such bleeding can be ignored and mask blood from a dangerous source like colorectal cancer, so persistent rectal bleeding should be investigated with a colonoscopy. External hemorrhoids cause most of the symptoms - pain, burning, and itching. Unirritated hemorrhoids can look like small skin tags coming out of the anus. If an external hemorrhoid becomes strangulated (cut off from blood supply), a clot can form in it and become an excruciatingly painful, thrombosed hemorrhoid. Because of these unpleasant symptoms, external hemorrhoids get the most treatment attention. PREVENTION Avoiding the causes listed in above will prevent most cases of hemorrhoids, but this advice is sometimes hard to follow: How can you avoid sitting all day if you have a seated job? Also, we try to avoid coughing and diarrhea, but sometimes it’s beyond your control. Still, there are some practical hints to help: If your main job activity is seated, always stand or walk during your breaks. Make it a point to stand and walk at least 5 minutes every hour and try to shift frequently in your chair to avoid direct rectal pressure. Always exhale as you strain or lift. Don't hold your breath. Treat coughing, diarrhea and constipation early since irritated hemorrhoids may soon follow. Do not delay or try to prevent a bowel movement when the urge is present. Exercise regularly (walking or jogging 30 minutes a day) to stimulate the bowels to move. Avoid dry toilet paper when cleaning after bowel movements. Moistened tissues such as baby wipes are less irritating. Lightly pat the rectal area dry Keep the rectal area dry. Talcum or baby powders can help. GET YOUR STOOLS SOFT. This is the most important way to prevent irritated hemorrhoids. Hard stools are like sandpaper to the anorectal canal. To have soft, regular bowel movements: Drink at least 8 tall glasses of water a day. Take plenty of fiber. Fiber is the undigested part of plant food that passes into the colon. Certain types of fiber can absorb and hold large amounts of water. This, in turn, results in a larger, bulkier stool, which is soft and easier to pass. Work gradually up to 3 servings a day of fiber (even more if needed) in the form of: Whole grain breads (whole wheat) Bran cereals Vegetables -- Root (potatoes, carrots, turnips), leafy green (lettuce, celery, spinach), or cooked high residue (cabbage) Fruit -- Cooked or stewed (prunes, applesauce) or fresh fruit (skin and pulp) Bulking Agents -- This type of water-retaining fiber generally is easily obtained each day by one of the following: Food bran -- This is available as wheat, oat or rice bran. Processing of wheat and other grains removes this valuable fiberous part of the food so these processed products should be avoided. Psyllium bran -- The psyllium plant is remarkable because its ground seeds can retain so much water. This product is available as Metamucil, Konsyl, Effersyllium, Per Diem Fiber, or the less expensive generic preparation in drug and health food stores. Although labeled a laxative, it really is not a laxative. Methylcellulose -- This is another fiber derived from wood which also retains water. It is available as Citrucel. No reading or other relaxing activity while on the toilet. If bowel movements take longer than 5 minutes, you are too constipated AVOID CONSTIPATION. High fiber and water intake usually takes care of this. Sometimes a laxative is needed to stimulate more frequent bowel movements, but Laxatives are not a good long-term solution as it can wear the colon out. Osmotics (Milk of Magnesia, Fleets phosphosoda, Magnesium citrate, MiraLax, GoLytely) are safer than Stimulants (Senokot, Castor Oil, Dulcolax, Ex Lax) Do not take laxatives for more than 7days in a row. IF SEVERELY CONSTIPATED, try a Bowel Retraining Program: Do not use laxatives. Eat a diet high in roughage, such as bran cereals and leafy vegetables. Drink six (6) ounces of prune or apricot juice each morning. Eat two (2) large servings of stewed fruit each day. Take one (1) heaping tablespoon of a psyllium-based bulking agent twice a day. Use sugar-free sweetnner when possible to avoid excessive calories. Eat a normal breakfast. Set aside 15 minutes after breakfast to sit on the toilet, but do not strain to have a bowel movement. If you do not have a bowel movement by the third day, use an enema and repeat the above steps. If these preventive measures fail, you must take action right away! Hemorrhoids are one condition that can be mild in the morning and become intolerable by nightfall. TREATMENT You must first find the cause of your hemorrhoids and stop it. Treating the hemorrhoids themselves is pointless if you keep re-creating them. Review the above sections to help identify and minimize the source of the problem. Once hemorrhoids develop, there are two treatment goals: Take away the symptoms (burning, pain, itching) Shrink the hemorrhoids Start with Sitz baths (soaking the rectal area in hot water, in a shallow bath) 20 minutes at a time 3-4 times/day This is the most effective way to keep the area clean and relaxed. Most research confirms that this is an essential treatment to help the hemorrhoids to calm down Review the above sections to help identify and minimize the source of the problem. Constipation is often the trigger, so be sure to work to have daily, soft bowel movements. Topical medications can be used for aching, burning and itching. Anusol HC cream (hydrocortisone 1%). For swollen external hemorrhoids, brands containing hydrocortisone such as this one are effective at reducing the swelling, burning, and itching sensations. Anusol HC suppositories (hydrocortisone 1%). These hydrocortisone suppositories should be used for internal swelling and discomfort. Tucks pads can help relieve symptoms Cleanse the entire rectal area with warm water after each bowel movement. Dab the area dry with minimal contact with the inflamed hemorrhoid(s). Avoid dry toilet paper since this is very irritating (=sandpaper feeling). Keep the rectal area dry with talcum or other non-irritating powders Avoid narcotics (Vicodin, Percocet, oxycodone, codeine) as these medications increase constipation, making the hemorrhoids more irritated with hard bowel movements. Use ibuprofen (Advil, Motrin) or Tylenol to help treat soreness. Avoid long-term use Aggressive treatment using the above techniques should improve hemorrhoids within days, but they may need 2-4 weeks of treatment to completely calm down. If they have not resolved to your satisfaction in that time, consult a physician for such issues as: Frequent bloody bowel movements can be from hemorrhoids or other sources Painful, dark hemorrhoids may be a sign of thrombosis Thrombosed hemorrhoids are always very hard, have a smooth black or purple surface, and feel like a growth coming from the anus. Thrombosed hemorrhoids form when the blood supply to the hemorrhoid is choked off and the vessels in the hemorrhoid clot. They are extremely painful, and a tiny incision made by a physician to remove the clot alleviates pain and bulging immediately. Don't delay seeing your doctor for a thrombosed hemorrhoid. Left alone, they take days or even weeks to go away. Hemorrhoids that come out of the anal canal with straining (prolapse) and will not reduce into the rectum can be at risk for choking off and dying Other medical problems such as inflammatory bowel disease or bowel infection can cause hemorrhoid-like symptoms.

Regional Surgical Specialists 2006